Healing is just one aspect of a hospital stay. For patients and their families, there are many clinical opinions, specialist referrals, treatment choices, and financial considerations at play--navigating all of that can be a confusing and overwhelming process. They need an advocate, someone who foresees their needs, knows their options, and begins strategizing their way home from the moment of admission.

UPMC Hamot is looking for a full-time Professional Care Manager to coordinate the care plan for its patients. The Care Manager is an expert in resource management, a master of regulatory compliance, a superb communicator, and above all a compassionate partner for each individual patient. Able to balance complex clinical scenarios with the patient’s social, emotional, spiritual, and economic needs, the Professional Care Manager is a strong clinician who works closely with physicians, nurses, and other caregivers to assist in progressing the patient along the continuum of care.

This position will work standard daylight hours, Monday through Friday.

**Nurses with 2 years of nursing experience may be considered for this position. The title and pay rate of the position may vary depending on education level and any years of relevant case management background**

An essential member of the care delivery team, you will apply your own judgment and problem-solving skills to ensure each patient is provided with efficient, quality care while minimizing risks, delays, and unnecessary costs. You will work hand-in-hand with the multidisciplinary team as well as internal and external providers and agencies to execute a safe discharge and a clear path forward for patients and their families, including plans for self-management, at-home care, and post-acute referrals and outreach, as needed.

The Professional Care Manager is a valued step in the UPMC nursing career ladder, with opportunities for continued growth and upward advancement.

Responsibilities:

Attends Department meetings and Corporate Care Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources. Ensures compliance with all payer and government regulations.

Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.

Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.

Starts discharge planning on admission and ensures DC documentation is completed and updated regularly. Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge. Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge. Documents all Avoidable Days in CANOPY system.

Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC. Initiates acceptance of lower LOC when appropriate with assistance from billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

Healing is just one aspect of a hospital stay. For patients and their families, there are many clinical opinions, specialist referrals, treatment choices, and financial considerations at play--navigating all of that can be a confusing and overwhelming process. They need an advocate, someone who foresees their needs, knows their options, and begins strategizing their way home from the moment of admission.

UPMC Hamot is looking for a full-time Professional Care Manager to coordinate the care plan for its patients. The Care Manager is an expert in resource management, a master of regulatory compliance, a superb communicator, and above all a compassionate partner for each individual patient. Able to balance complex clinical scenarios with the patient’s social, emotional, spiritual, and economic needs, the Professional Care Manager is a strong clinician who works closely with physicians, nurses, and other caregivers to assist in progressing the patient along the continuum of care.

This position will work standard daylight hours, Monday through Friday.

**Nurses with 2 years of nursing experience may be considered for this position. The title and pay rate of the position may vary depending on education level and any years of relevant case management background**

An essential member of the care delivery team, you will apply your own judgment and problem-solving skills to ensure each patient is provided with efficient, quality care while minimizing risks, delays, and unnecessary costs. You will work hand-in-hand with the multidisciplinary team as well as internal and external providers and agencies to execute a safe discharge and a clear path forward for patients and their families, including plans for self-management, at-home care, and post-acute referrals and outreach, as needed.

The Professional Care Manager is a valued step in the UPMC nursing career ladder, with opportunities for continued growth and upward advancement.

Responsibilities:

Attends Department meetings and Corporate Care Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources. Ensures compliance with all payer and government regulations.

Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.

Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.

Starts discharge planning on admission and ensures DC documentation is completed and updated regularly. Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge. Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge. Documents all Avoidable Days in CANOPY system.

Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC. Initiates acceptance of lower LOC when appropriate with assistance from billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

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